Managing AKT Inhibitor Adverse Events in mHSPC

In this video, Scott Sellinger, MD, FACS, discusses important considerations for urologists who may be prescribing capivasertib (Truqap) for the first time following its approval in PTEN-deficient metastatic hormone-sensitive prostate cancer. He notes that capivasertib has a toxicity profile that may be less familiar to urologists compared with medical oncologists, who have more experience using AKT inhibitors in other solid tumors. Sellinger highlights hyperglycemia, gastrointestinal effects—particularly diarrhea—and skin rash as the key adverse events clinicians should anticipate when initiating treatment.

Sellinger emphasizes that comprehensive patient education is one of the most important steps before starting therapy, particularly because proactive counseling can help prevent unnecessary emergency department visits or treatment interruptions. He recommends assessing baseline metabolic health, including a patient’s history of diabetes, prediabetes, and glucose control, while noting that patients with poorly controlled diabetes were excluded from the pivotal trial of the agent and may require additional caution in practice. He also stresses the importance of discussing potential gastrointestinal and dermatologic toxicities upfront so patients understand when to contact their care team and when intervention may be needed.

Discussing toxicity management strategies, Sellinger explains that early intervention is critical for maintaining patients on therapy. For hyperglycemia, he recommends baseline evaluation such as hemoglobin A1C and glucose monitoring, with consideration of interventions such as dietary counseling or metformin in appropriate patients. For diarrhea, he highlights hydration and early use of antidiarrheal medications, while for rash, he recommends minimizing sun exposure and promptly addressing symptoms. Sellinger also discusses the role of dose interruptions and reductions, noting that clinicians can rely on established toxicity-management guidance and oncology experience to adjust treatment while balancing efficacy and tolerability.